Testicular Cancer

Topic Overview

What is testicular cancer?

Testicular cancer
occurs when cells that aren't normal grow out of control in the
testicles (testes). It is highly curable, especially
when it is found early.

The testes are the two male sex organs
that make and store
sperm. They are located in a pouch below the penis
called the
scrotum. The testes also make the hormone
testosterone.

Testicular cancer is rare. But it is the most common cancer among young men.

Most testicular cancers start in cells that make sperm. These cells are called germ cells. The two main types of testicular germ cell cancers are seminomas and nonseminomas. Seminomas grow and spread slowly
and respond to radiation therapy. Nonseminomas grow and spread more quickly than seminomas.
There are several different types of nonseminomas.

This topic covers seminoma and nonseminoma cancer. It does not cover non-germ cell testicular cancers, such as Leydig cell tumors.

What causes testicular cancer?

Experts don't know
what causes testicular cancer. But some problems, such as having an undescended testicle or Klinefelter syndrome, may increase a man's risk for this cancer. Most men who get testicular cancer don't have any risk
factors.

What are the symptoms?

The most common symptoms of
testicular cancer include:

A lump or swelling in the scrotum that may or may not be painful.

A heavy feeling in the
scrotum.

A dull pain or feeling of pressure in the lower belly or groin.

How is testicular cancer diagnosed?

Most men find
testicular cancer themselves by chance or during a
self-exam. Or a doctor may find it during a
routine physical exam.

Because other problems can cause symptoms
like those of testicular cancer, your doctor may order tests to find out if you
have another problem. These tests may include blood tests and imaging tests of
the testicles such as an
ultrasound or a
CT scan.

If these tests show signs of cancer, you will have surgery to remove the testicle. Surgery is the only way to know for sure if you have testicular cancer and what kind of cancer it is. This information also helps
in planning any other treatment you may need.

How is it treated?

For some men, surgery to remove the testicle may be all the treatment they need. The type and stage of your cancer will help your doctor know if you need more treatment.

Treatment after surgery may include surveillance, chemotherapy, or radiation therapy. Chemotherapy is often used for cancer that has spread to
other parts of the body. In some cases, surgery is used to remove that kind of
cancer.

How will having testicular cancer affect you?

In
most cases, removing a testicle doesn't cause long-term sexual problems or
make you unable to father children. But if you had these problems before
treatment, surgery may make them worse. And other treatments for cancer may
cause you to become infertile. You may want to think about saving sperm in a
sperm bank. Talk to your doctor if you have any questions or concerns about
sexual problems or whether you can father children.

Some men
choose to get an artificial, or prosthetic, testicle. A surgeon places the
artificial testicle in the scrotum to keep the natural look of the
genitals.

Cause

Experts don't know
what causes testicular cancer. But some problems, such as having an undescended testicle or Klinefelter syndrome, may increase a man's risk for this cancer. Most men who get testicular cancer don't have any risk
factors.

Symptoms

Common symptoms of
testicular cancer include:

A swelling and/or lump in one or both of the
testes. You may or may not have pain in the testes or scrotum.

Symptoms of advanced testicular cancer

Testicular cancer that has spread (metastasized)
beyond the testicles and regional
lymph nodes to other organs may cause other symptoms
depending on the area of the body affected. Symptoms of late-stage testicular
cancer may include:

Dull pain in the lower back and
belly.

Lack of energy, sweating for no clear reason, fever, or
a general feeling of illness.

Shortness of breath,
coughing, or chest pain.

Headache or confusion.

What Happens

In most cases, the first sign of
testicular cancer is a change in the size or shape of
one or both testicles (testes). Often this change doesn't cause pain, though
pain may be present. If unnoticed or untreated, testicular cancer may spread
(metastasize) to other areas of the body.

After you are diagnosed with testicular cancer, you and your doctor will begin planning your treatment. Nearly all men with testicular cancer have surgery. After surgery, you may have other treatments, if they are needed. This depends on your choices, the type of cells involved, and the stage of your cancer.

Testicular cancer is one of the most curable forms of cancer, especially
during its early stages. If you have symptoms of testicular cancer, see a
doctor as soon as possible.

When To Call a Doctor

Call your doctor as soon as
possible if you have any symptoms of testicular cancer, including:

A swelling or lump in one or both of the
testes. You may or may not have pain in the testicles or scrotum.

A heavy feeling in the scrotum.

A dull pain or feeling
of pressure in the lower belly or groin.

Surveillance

Some early-stage testicular cancers are successfully managed
with
a "wait-and-see" approach after surgery. This option involves frequent exams as well as blood tests and
imaging tests to watch your condition. Surveillance may let you avoid the side effects from other follow-up treatments, such as chemotherapy and radiation therapy.

If the ultrasound and blood tests suggest testicular cancer, a doctor will surgically remove your affected testicle. It will be checked for cancer. If cancer is found, you may have other tests, such as X-rays, CT scans, or MRIs, to find out the stage of your cancer.

Ongoing exams and tests

During your
treatment for testicular cancer, your doctor will schedule a thorough follow-up
program to monitor your recovery, especially if you are doing
surveillance. These exams and tests may continue for several years. In addition to physical exams, your follow-up program may include:

Periodic imaging tests such as chest X-rays or
CT scans.

Blood tests to check the levels of tumor markers in your blood.
Tumor marker levels that are stable or that increase after you've had treatment
may be a sign of more cancer.

Early detection

Testicular self-exam may help detect testicular cancer. These cancers may be first found as a painless lump or an enlarged testicle during a self-exam.

Some doctors recommend that men ages 15 to 40 perform monthly testicular self-exams (TSE). But many doctors don't believe that monthly TSE is needed for men who are at average
risk for testicular cancer. Monthly TSE may be recommended for men who are at
high risk for this kind of cancer. This includes men who have a history of an
undescended testicle or a family or personal history of testicular
cancer.

Treatment Overview

If you are diagnosed with
testicular cancer, your doctor will explain what type
of cancer you have, whether it has spread beyond the testicle (metastasized),
and the potential for curing it. You and your doctor will discuss your
treatment options and possible outcomes of those treatments. Testicular cancer
is highly curable, especially when it's diagnosed at an early
stage.

If the cancer isn't treated during its early stages, it may spread (metastasize) to the lymph nodes and to the lungs, liver, brain, and bones. But often testicular cancer that has spread can still be treated successfully.

Some cancer treatments raise your risk of
infertility. Unless you are sure you won't want to father a child in the
future, talk to your doctor about sperm banking before any treatment for
testicular cancer.

Treatment begins with surgery (orchiectomy) to remove the affected testicle. After surgery, depending on which type of cancer cells are
present and whether your cancer has spread to other areas of your body (stage), you may need only surveillance. Or you may need further treatment.

Most testicular cancers are either seminomas or nonseminomas. The main difference between the two is that seminomas grow and spread slowly and respond to radiation therapy. Nonseminomas grow and spread more quickly than seminomas. They don't respond to radiation.

Additional information about testicular cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/testicular.

Seminomas

Seminomas are the kind of testicular cancer that grow and spread slowly. After surgery, treatments may include:

For seminomas that are more advanced (stage II or stage III cancers), treatments begin with surgery (orchiectomy) and may include radiation, chemotherapy, or combination chemotherapy. After chemotherapy, tissue masses that remain may need to be removed with surgery.

Nonseminomas

Nonseminomas are the kind of testicular cancer that grow and spread more quickly than seminomas. They don't respond well to radiation therapy. After surgery, treatments may include:

For nonseminomas that are more advanced (stage II or stage III cancers), treatments begin with surgery (orchiectomy) and may include surgery to remove lymph nodes, chemotherapy, or combination chemotherapy. After chemotherapy, any tissue masses that remain will be removed with surgery, if possible.

Treatment choices

If your cancer was found early, you may have a choice about further treatment. Talk with your doctor about the risks and possible side effects of each treatment option.

Blood tests to check tumor marker
levels. Stable or increasing tumor marker levels after treatment may mean that your
cancer is still present or has returned. You may need more treatment.

A diagnosis of testicular cancer means that you will be
seeing your doctor regularly for years to come. It's a good idea to build
a relationship based on trust and the sharing of information. Your doctor may
give you some advice on changes to make in your life to help treatment succeed.

Cancer that has come back

Testicular cancer that has come back (recurred) may be
found during a physical exam, through an imaging test, or as a result of
increasing tumor marker levels. In some cases, recurrent cancer can be successfully treated. This is especially true if the cancer has spread only to
the lymph nodes in the pelvis, belly, or lower back and pelvis.

Recurrent testicular cancer may be treated with chemotherapy, surgery to remove lymph nodes, or radiation. Chemotherapy may be followed by surgery to remove any remaining cancer.

Palliative care

Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life-not just in your body but also in your mind and spirit.
You can have this care along with treatment to cure your illness.

Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.

End-of-life care

For some people who have advanced cancer, a time comes when treatment to cure the cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But you can still get treatment to make you as comfortable as possible during the time you have left. You and your doctor can decide when you may be ready for hospice care.

Prevention

There are no proven ways to prevent
testicular cancer.

Home Treatment

Home treatment can help you manage the side effects that may occur from your treatment. Some treatments for testicular cancer, such as chemotherapy or radiation, can have serious side effects. Be sure to follow any instructions and take medicines given to you by your doctor.

Manage side effects

Home treatment for nausea or vomiting
includes watching for and treating early signs of
dehydration, such as having a dry mouth or feeling lightheaded when you stand up. Eating smaller meals may help. So can a little bit of ginger candy or ginger tea.

Home treatment for diarrhea includes resting your
stomach and being alert for signs of dehydration. Check with your doctor before
using any nonprescription medicines for your diarrhea.

Home treatment for constipation includes gentle
exercise along with adequate intake of fluids and a diet that is high in
fruits, vegetables, and fiber. Check with your doctor before using a laxative
for your constipation.

Home treatment for fatigue includes
making sure you get extra rest while you are receiving chemotherapy or
radiation therapy. Let your symptoms be your guide. You may be able to follow
your usual routine and just get some extra sleep. Fatigue is often worse at the
end of treatment or just after treatment is completed.

Home treatment for pain includes using nonsteroidal anti-inflammatory medicines (NSAIDs) or
an alternative therapy, such as
biofeedback. Be sure to talk to your doctor before using any over-the-counter pain relievers.

Finding out that you have cancer can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit its website at www.cancer.org.

Practice healthy habits

Healthy habits such
as eating a balanced diet and getting enough sleep and exercise may help
control your symptoms.

Eat well. Try to eat a
balanced diet to prevent weight loss and to conserve your strength during
treatment for testicular cancer.

Get enough sleep. If you find you have trouble sleeping,
be sure to have a regular bedtime, get some exercise during the day, avoid
caffeine late in the day, and follow other tips to help you sleep more
easily.

Manage your feelings

Manage stress. This may include expressing your feelings to others. Relaxation techniques, such as meditation, and support groups may help too.

Understand hair loss. Hair loss can be emotionally
distressing. Talk to your doctor
about whether hair loss is an expected side effect with the medicines you will
receive.

Accept your emotional reactions. Your reactions may make it harder to make decisions about your health. Talk with your doctor or others about your feelings.

Understand your feelings about your body and your sexuality. Your attitudes may change following treatment for cancer. Your doctor may be able to refer you to organizations that can offer additional support and information.

Surgery to remove other areas of cancer if it has spread in the body. This is done for nonseminoma cancer, either before or after having chemotherapy.

Other Treatment

Radiation therapy

Radiation therapy for testicular cancer uses high-dose
X-rays or other types of radiation to kill cancer cells. The type of radiation used to treat testicular cancer is external beam radiation. This means the radiation comes from a machine outside the body and is aimed at a specific part of your body.

Radiation therapy may be used to treat the seminoma type of testicular cancer. Because the lymph nodes in the pelvis and lower back are the most common areas for testicular cancer to spread, radiation is often focused on that area.

You may have a choice between
radiation therapy or another treatment. When making your decision, talk to your doctor about the risks and possible side effects of
radiation therapy.

Complementary therapies

People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:

Mind-body treatments like the ones listed above may help you feel better. They can make it easier to cope with cancer treatments. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.

Before you try a complementary therapy, talk to your doctor about its potential value and side effects. Let your doctor know if you are already using any such therapies. These therapies aren't meant to take the place of standard medical treatment. But they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.

Other Places To Get Help

Organizations

American Cancer Society (ACS)

250 Williams Street NWAtlanta, GA 30303

www.cancer.org

National Cancer Institute (U.S.)

www.cancer.gov (or https://livehelp.cancer.gov/app/chat/chat_launch for live help online)

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